Provider Demographics
NPI:1588346779
Name:CHEATHAM, EMMA (PA)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:CHEATHAM
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:375 N WALL ST STE P530
Mailing Address - Street 2:
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-3486
Mailing Address - Country:US
Mailing Address - Phone:815-932-7200
Mailing Address - Fax:815-935-7874
Practice Address - Street 1:375 N WALL ST STE P530
Practice Address - Street 2:
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-3486
Practice Address - Country:US
Practice Address - Phone:815-932-7200
Practice Address - Fax:815-935-7874
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program